WASHINGTON – President Donald Trump and Republican leaders in Congress have repeatedly said Obamacare is failing, or even dead. Yet there are signs across the country that support for the Affordable Car Act’s programs is stronger than opponents have portrayed.
This past week in Virginia, where Democrats won a competitive race for governor, two-thirds of voters called health care a “very important” or the most important issue, according to one poll. Maine voted to expand Medicaid under the law, something the Republican governor had sworn not to do.
Enrollment under the law also appears strong in its first week – the federal government released data Thursday showing that sign-ups in the first 4 days were higher than a year ago, when President Barack Obama’s administration was running it.
Trump’s repeated insistence that the law is a disaster, and congressional Republicans’ attempts to repeal it, may have had the opposite effect from what they intended. Despite the administration slashing advertising for the enrollment period that started Nov. 1, and other steps to destabilize it, early signs indicate people are embracing the health program.
Trump’s frequent attacks on the law may have only brought more attention to it, said Dan Mendelson, president of Avalere, a health care consulting company.
“The reality is that the administration has been aggressively messaging about the exchanges,” Mendelson said. “They’ve actually done outstanding marketing so far. Awareness of the program has never been higher.”
Initial sign-up numbers for the first 4 days of enrollment in 2018 plans in most states totaled more than 600,000, up 45 percent from last year, according to the Centers for Medicare and Medicaid Services. Of those, 137,322 were new customers.
Those positive signs for the law are early markers, and could change.
Maine and Virginia are just two states, and Democrats face challenging Senate midterm elections next year. The administration also still has broad authority over how the law is administered, and Republicans debating tax legislation in Congress are talking about repealing a key requirement of the program that all Americans have coverage or pay a fine.
The enrollment season in most states lasts until Dec. 15, about half as long as last year. Karen Pollitz, senior fellow at the Kaiser Family Foundation, said it’s too early to draw conclusions about how many people will sign up, or whether the mix of sick and healthy customers will be profitable for insurers.
But the initial enrollment report lessens the fears “that this could be a real bust,” Pollitz said. The sickest often sign up early while healthy people wait until the end of the enrollment period to decide.
In Virginia, Democrat Ralph Northam’s opposition to the repeal helped elect him governor, according to Public Policy Polling, which conducted the survey in the Virginia race.
“All this discussion about repeal made people aware that, ‘Wow, I should be grateful for what I have access to,”’ said Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University in Fairfax, Virginia.
One of Trump’s efforts to starve the law may have enticed some people to sign up. The president cut off funding for insurer subsidies under the Affordable Care Act that are meant to help low-income people cover health care costs, a move that caused insurers to raise premiums even more.
Because of how the law is written, the government was forced to increase the financial help it provides lower-income people to buy insurance. That meant that for some people, the amount they have to pay to buy coverage is lower than last year.
An analysis by the left-leaning think tank Center for American Progress found “hundreds of scenarios” in which consumers could get coverage free. For example, a single 27-year-old who earns $25,000 a year could find coverage that would cost nothing in more than a quarter of 2,722 counties the group examined.
Low-income people have “really been very motivated about by being able to get insurance at no cost,” Avalere’s Mendelson said. The quirk doesn’t benefit higher-income people, who will have to choose between paying higher premiums or forgoing coverage.
Officials in New York, Maryland, Massachusetts and California, which operate their own Obamacare marketplaces instead of relying on the federal sign-up system, also said early enrollment numbers are higher than last year.
In Maryland enrollments doubled to 10,000 in the first six days, said Andrew Ratner, chief marketing officer for the Maryland Health Benefit Exchange. That counts new enrollees and returning customers who logged in to change plans.
At CareSource, which sells policies in Ohio, Kentucky, Indiana, and West Virginia, overall sign-ups are higher than during the same period last year, said Steve Ringel, president of the health insurer’s Ohio market, exceeding projections.
The controversy around the ACA and attempts to repeal it “definitely has heightened awareness, and that heightened awareness has been a positive,” Ringel said. “Those consumers who are subsidized are finding very affordable care and options.”
(Edney reported from Washington and Tozzi from New York)
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